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I’m taking a break from blogging this summer as I focus on my move, but in the meantime I have some great guest posts on various topics lined up from the autoimmune community. This post is by Sarah Ramsden.

Changing your diet and lifestyle to address an autoimmune condition, can be nothing short of overwhelming. You need to start paying attention to thinks you never considered before, like your sleep, spending time outdoors, and really addressing stress. You can’t eat many of your old favorites, and for the true healing effects of food, you have to add in things that you’d never in a million years consider otherwise. For me, that was fermented foods.

The week I was diagnosed with the autoimmune condition multiple sclerosis, I was also told I had a brain tumour called a meningioma. In a matter of weeks I was under the knife having brain surgery, which led to 3 months off work to recover, and the rest of the year slowly adding in pieces of my life until I was running at full steam again. Only then did I have the mental space to start thinking about MS.

A life long reliance on medication didn’t appeal to me, and I looked elsewhere for answers. That’s when I discovered the concept of going grain free, which led to paleo, and then the autoimmune protocol. The fermented foods came last, and I tentatively added them to my own plate several years ago through necessity. I’ll be honest, the idea frightened me a little (adding bacteria to my food?!), but they won me over with their delicious flavour.

While the research into the role specific bacterial strains play in our body is on-going, we do know that eating fermented foods on a regular basis is beneficial when addressing autoimmune disease. A healing addition to your diet, they are involved in immune modulation; fighting infection; speeding the healing process; have anti-inflammatory effects; and provide digestive benefits such as improving the integrity of the gut mucosal barrier, and helping to correct gut dysbiosis (an imbalance in gut bacteria).

Today I’m going to pass on some tips around the practicalities of fermented foods and autoimmunity that I’ve learned not only from my personal experience, but also from working with clients in my nutrition practice.

Getting started with fermented foods:

If you are new to fermented foods, start by choosing something familiar to you, there’s no need to make it more intimidating than it needs to be! I was a pickle addict as a kid so that’s where I started. If you used to love sauerkraut on your hot dog then that’s your sweet spot, or if you have a thing for fizzy drinks try kombucha. There’s no right or wrong place to start as long as the ingredients fall within what you can tolerate on the autoimmune protocol.

Buy raw and unpasteurized:

Unfortunately, the majority of “fermented foods” found in mainstream grocery stores are completely lacking in the beneficial bacteria and yeasts that make them so healthy. In order to maintain a consistent texture and flavour, the majority of brands pasteurize their products to make them shelf stable, and this process kills the health-promoting nature of the product.

In some of these shelf stable “ferments” such as pickled cucumbers and onions, the standard is now to use vinegar as a preserver rather than the traditional brine used in fermentation. Add pasteurization to the mix, and again you’re not getting the beneficial effects you might expect. The rule is, that if something is on the shelf, it’s been pasteurized. If it’s in the fridge, it’s typically unpasteurized. You can double check by looking for raw and unpasteurized on the label.

Read the ingredients:

As with anything, it’s still important to read ingredients. Not only will you avoid ingredients that might disagree with you, like mustard seeds in pickles, or fennel seeds in sauerkraut, but you’ll also get a second confirmation of the raw and unpasteurized nature of the product. In vegetable based ferments you’re looking for simple ingredients like “water, vegetables, salt”, and in the case of something like kombucha you want to see “water, sugar, tea, culture”. If there’s another form of sweetener at the end of the list, you know it has been sweetened after the fermentation process, an unnecessary step and best avoided by you.

Variety is key:

Once you’re comfortable with your first ferment, start introducing new ones. Just as variety is important in your diet to make sure you get a full spectrum of nutrients, a variety of ferments will also diversify the bacteria you’re exposed to. There’s a huge number to choose from that are AIP compliant, for example there’s sauerkraut, lacto-fermented vegetables like carrots, broccoli, cauliflower, sweet potatoes and pickled cucumbers, beet kvass, fermented fruit, kombucha, and water kefir.

Quantity and frequency:

Fermented foods aren’t a quick fix, but bring positive changes with consistent use. When you start eating fermented foods, start slowly; maybe a ¼ cup of fermented vegetables, or half a cup of kombucha for instance. I recommend to my clients with autoimmune conditions, that they aim to eat or drink a ferment daily, ideally with every meal. My personal approach is to have a glass of kombucha with breakfast, and sauerkraut or some kind of lacto-fermented vegetable (cauliflower is my favorite) with lunch and dinner.

Dealing with symptoms:

Like any dietary introduction, pay attention to any symptoms that may result, looking for signs of digestive distress, fatigue, anxiety, depression, mood changes, or a flare up of skin issues. If you do experience symptoms, the first thing to do is to rule out a sensitivity to an ingredient in the ferment as opposed to the fermented nature of the food. So if you eat sauerkraut and experience bloating, double check that cabbage, or cruciferous vegetables in general aren’t the issue. Then you can determine that it’s the addition of the bacteria and yeasts that are the root cause of your symptoms. Most commonly, this is the result of an imbalance in gut bacteria called dysbiosis.

Once symptoms have subsided, reduce your serving size and try again. If you find you’re particularly sensitive, don’t underestimate the positive effect of even a very small amount of fermented food or drink. Some people can only tolerate a spoonful of sauerkraut juice to begin with, and then slowly graduate up to adding in the vegetable, and later increasing quantity and frequency.

People who should be cautious:

Those of you with a histamine sensitivity will have problems with many fermented foods, but before you give up, try kombucha which is known to be better tolerated. Likewise, if you have a yeast sensitivity, you may have to rely on probiotic supplements because while fermented foods are known for their beneficial bacteria, they also contain beneficial yeasts that can cause a reaction.

Take care of your microbiome:

While our digestive system holds the majority of the bacteria in our body, we are literally covered in them, from our skin, to our eyes, to in our noses, mouths, and in women, the vagina. There are literally 10 times the number of them, than there are our own cells! An overall approach to taking care of these guys, who mutually take care of you, involves a variety of steps. Firstly, if you’re doing AIP you’re already eating a wide variety of vegetables that influence the health of your friendly bacteria.

Next, remove all anti-microbial cleaners, soaps and supplies from your home. Instead you can replace them with all natural soaps, solutions like Norwex Microfibre Cloths, and probiotic products like PIP Perfect Skin Hygiene Spray. It goes without saying that you should be very selective in your antibiotic use.

Finally, get outdoors and get dirty; do some gardening, play with your kids in the sandbox, and get regular contact with animals, whether they be pets in your home, or animals on a farm. The dirt on your (organic) vegetables is beneficial too, so when you prepare them, give them a gentle rinse rather than a scrub. A little dirt goes a long way!

Make your own:

Once you get into the habit of including fermented foods and drinks you’ll start noticing that the price tag, it can add up quickly! It doesn’t have to though, as making your own gives you high quality, health-promoting ferments at a fraction of the price. It might seem intimidating at first, but I promise that it can be easy, and even fun. There’s no better time to start making your own fermented foods and drinks.

Sarah Ramsden is a Certified Nutritional Practitioner, teacher and speaker. She’s a brain tumor survivor thriver, and manages multiple sclerosis naturally. Based in Toronto, Canada she works with clients around the country helping them change their expectations and take control of their health. She has helped alleviate everything from autoimmune disorders, to irritable bowel syndrome, adrenal fatigue, mental health issues and blood sugar disregulation. She's the co-creator of S&S TV.

27 comments

Hey Jenny! Typically fermented foods are high in histamine (no doubt in part because the food sits around for a long time), which is why is problematic for those with the sensitivity. There’s something about the kombucha fermentation process that’s different, and to be honest I’m not certain on the mechanisms behind it, but I have had good results with my clients! Sarah Ballantyne mentioned it in her book “The Paleo Approach” too. If you’re sensitive to histamine, I’d only start with a very small serving to test it out, and increase from there.

I have IBD and had J-pouch surgery 20 years ago. I currently have a fistula and would prefer to go the Probiotic path as well. Many foods cause distress to the extent that experimentation is miserable and simply not an option. What would you recommend as a Probitic to start?

Hi Tracy! I can’t advise on medical conditions since I am not a doctor. You’ll need to ask your doctor if fermented foods are advisable for you or if supplementation with a probiotic supplement is better. Hope it helps!

Hi! I have tried probiotics supplement and fermented vegetables and get serious illness after about a week. I have done some research and it seems like I had die off experiences both times I have tried, including vomiting. I eat a paleo diet and have cured my acne 95 % but think I need to heal my gut and probiotics is a step on the way. For now I´m afraid of starting with probiotics or fermented vegetables again because of how bad I got both times. Both times I stopped taking/eating the probiotics because I got so bad. Can you please help me with this?

Hi Tomas! I’m so sorry to hear of your issues with taking probiotics and eating fermented foods! Unfortunately there could be a lot of factors to your situation, and you should probably seek the advice of a doctor or a nutritionist to sort out why your reaction was so bad. Sometimes it is something like SIBO, or an intolerance to histamine that can be a problem. Good luck!

Hi! I’m doing paleo autoimmune diet since 3 weeks and I’m gonna start eating fermented vegtebales but I have a question. My mom makes some fermented vegtebales at home. For example she makes fermented cabbage. But she puts some chickpeas in it to make it fermented. She cuts the cabbage puts in a big bottle and fill it with water. And she also puts salt and 5-6 chickpeas inside. After one week it’s fermented. And she takes the chickpeas out. What I wonder is that if it’s okay to eat this. Because there is chickpeas inside. I would appreciate if you would help me with this. Thank you so much.

Hi Ebru! Chickpeas are not included on the autoimmune protocol, so if you are going to try a strict elimination you should see if your mom minds trying her recipe without. Chickpeas are not required for fermentation, but I suspect she uses them for flavor. Many of us have made ferments with just cabbage (or other AIP veggies like carrots or beets), water and salt and they come out delicious! Hope it helps 🙂

Hi Sanni, In order to realize the benefits of eating the probiotic food, you’ll want to eat the sauerkraut raw instead of using it for cooking. I’m not sure about the figures on how much bacteria is destroyed.

[…] the damages caused by autoimmune diseases. Some examples of nutrient-dense foods are bone broth, fermented vegetables, fatty fish, shellfish, and offal. While most of these are already pretty mainstream, some of us […]

Is the water kefir safe for the AIP diet since it has sugar? Or does enough of it dissolve? I just started making water kefir soda. I have gotten a lot sicker since starting it so I suppose I should back off to 1 tablespoon a day? (I just enjoy the flavor)

Hi Shaun! Personally, I don’t make my own ferments very often because I prioritize making most of my own meals from scratch, which is time consuming! I say whether you are making or purchasing, including them in your diet is a great idea – just make sure if you purchase them they are raw and unpasteurized.

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